Our wrists
are made up
of 8 carpal
bones and a
intricate
web of
nerves and
ligaments.
These 8
bones
support an
area called
the carpal
tunnel. This
tunnel
contains
tendons and
the median
nerve.
One of the
most common
sites of
injury is
the wrist.
The wrists
are used in
a variety of
different
sports such
as
badminton,
tennis,
boxing and
are also
extensively
used when we
type and in
certain
occupations.
This
repetitive
motion of
certain
activities
makes some
people more
susceptible
to wrist
pain.
The majority
of falls
also result
in wrist
pain as we
naturally
outstretch
our hands to
cushion our
fall.

Wrist
Sprains

Introduction
A wrist
sprain is
stretching
or tearing
of the
ligaments
that support
the wrist.
Ligaments
are strong
bands of
tissue that
connect
bones to
each other.
This often
occurs due
to a fall on
an
outstretched
hand which
causes
ligaments to
stretch
which can be
very
painful.
Pain will be
present
around the
wrist and
there may be
some redness
and
bruising.
The patient
will
complain of
limited
range of
movement. A
wrist sprain
can be
classed in
three
different
grades:
1. Grade 1
Sprain:
Micro tear
of the
ligaments
2. Grade 2
Sprain:
Partial tear
of ligament
and
mid-joint
instability.
3. Grade 3
Sprain:
Severe or
complete
tear of
ligaments
and
significant
joint
instability.

Treatment
 R.I.C.E:
Rest (Avoid
using your
injured
wrist and
hand), Ice
(Apply ice
or a cold
pack to the
wrist for
15-20
minutes, 4
times a day
for several
days,
Compression
(Wrap your
wrist in an
elastic
support.
This will
limit
swelling and
support your
wrist) .and
Elevation (
Keep the
injured
wrist raised
above the
level of
your heart
for 48 hours
such as up
on a pillow.
This will
help drain
fluid and
reduce
swelling).
 Pain
Killers
(please
consult your
doctor for
advice
regarding
appropriate
pain
killers).
 Wrist
Braces,
 Surgery
may be
required if
the ligament
is
completely
torn or
their is an
associated
fracture.
 If the
sprain is
very severe
the wrist
may be
casted for a
weeks to
immobilize
the area to
allow
healing.

Rehabilitation
Rehabilation
exercises
and wrist
braces will
help speed
up recovery
and prevent
further
injury.You
may need to
wear a brace
to
immobilize
your wrist.
If you play
sports, you
may need to
wear a wrist
brace or
tape your
wrist when
you return
to play.

Arthritis
Wrist

IntroductionArthritis of
the hand and
wrist occurs
in one of
two major
forms:
inflammatory
arthritis,
including
conditions
such as
rheumatoid
arthritis,
and the more
common form
of
degenerative
arthritis is
known as
osteoarthritis.
Osteoarthritis
is the main
form of
arthritis
and is known
as the "wear
and tear"
disorder. It
can affect
any joint.
The wrist is
especially
susceptible
due to the
tremendous
amounts of
pressure
that is
placed
during
everyday
activities.
Osteoarthritis
causes the
cartilage to
erode and
then causes
the bone
ends to rub
against each
other which
results in
stiffness
and aching
of the
joints.
Osteoarthritis
can also
follow a
fracture or
a bad sprain
to the
wrist.
Rheumatoid
Arthritis is
a systemic
disease,
which
affects the
whole body.
In
rheumatoid
arthritis,
the joint
lining (synovium),
normally
smooth and
shiny,
becomes
inflamed,
painful and
swollen.
Rheumatoid
arthritis
can affect
all the
joints and
muscles in
the wrist.
It affects
more women
then men and
can be
inherited.
The insides
of the
joints
become
swollen and
stiff. It
affects the
wrist by
causing
stiffness,
swelling,
and the loss
of motion.
One common
symptom of
rheumatoid
arthritis of
the wrist is
diminished
grip
strength.
The fingers
of the hand
are able to
move because
of the
connection
of tendons
within them
to the
muscles of
the forearm.
There is
another form
of arthritis
that you
should be
aware of
called
infectious
arthritis.
Infectious
arthritis
(septic
arthritis)
is infection
in the fluid
and tissues
of a joint
usually
caused by
bacteria,
but
sometimes
caused by
viruses or
fungi. The
patient will
have
swelling of
the wrist
accompanied
by heat. He
or she will
also have a
fever and
touching the
wrist will
cause
extreme pin.
In such as
case visit
your local
accident and
emergency
department
as soon as
possible.

Symptoms
Rheumatoid
arthritis
 Painful,
swollen
joints.
 Tendons
are no
longer able
to work on
stable
joints,
often
resulting in
an unnatural
rotation of
the wrist.
Diminished
grip of the
fingers.
Osteoarthritis
 Stiffness
and pain in
a particular
joint.
 Your wrist
may fill
with fluid
and feel
tight,
especially
after use.
When all the
articular
cartilage is
worn off the
joint
surface, you
may notice a
squeaking
sound when
you move
your wrist.
Doctors call
this
creaking
crepitus.
Causes
Rheumatoid
arthritis
 Autoimmune
disease
which can be
inherited.
 May be due
to a virus.
Osteoarthritis
 Wear and
tear
disorder due
to
repetitive
use of a
particular
joint in the
body.
 Weak
cartilage
and bone
structure is
also a
contributing
factor.
 A bad
sprain or
wrist
fracture can
actually
damage the
articular
cartilage.
The
cartilage
can also be
"bruised"
when too
much
pressure is
put on the
cartilage
surface. The
cartilage
surface may
not look any
different.
The injury
often
doesn't show
up until
months
later.

Treatment
Osteoarthritis
of Wrist
 Treatment
is usually
conservative,
surgical
intervention
is rarely
considered.

Nonsteroidal
anti-inflammatory
drugs may be
prescribed
by the
doctor to
control the
pain.
 Heat
therapy and
products
such as
cryotherepy/cold
therapy are
very good to
alleviate
discomfort.
 Wrist
brace and
supports
will help to
reduce your
pain during
activity.
Range-of-motion
and
stretching
exercises
can improve
your wrist
motion.
Strengthening
exercises
for the arm
and hand
help steady
the wrist
and protect
the joint
from shock
and stress.
Rheumatoid
Arthritis of
wrist
 There is
no cure for
rheumatoid
arthritis.
In the
absence of
infection,
cortisone
injections
directly to
the wrist
can be very
helpful in
relieving
pain and
improving
flexibility.
 As with
osteoarthritis,
Nonsteroidal
anti-inflammatory
drugs may be
prescribed
by the
doctor to
control the
pain.
 Heat
therapy such
as the
reusable hot
and cold
pack will
reduce
discomfort
to the
wrist.
 Cortisone
is a very
powerful
anti-inflammatory
medication.
When
injected
into the
joint,
cortisone
can help
relieve the
pain. Pain
relief is
temporary
and usually
only lasts
several
weeks to
months.
There is a
small risk
of infection
with
cortisone
injections.
 Surgery is
only
recommended
if it can
stabilize
the joints
and deliver
pain relief.
Sometimes
the one or
more of the
eight bones
of the wrist
may be
replaced
with a
prosthesis,
helping
improve the
function of
the joint.
 Wrist
braces and
supports
will reduce
pain.
discomfort
and allow
the patient
to carry out
daily
activities
in less
pain.

Rehabilitation
Wrist
strengthening
exercises
will help
together
with heat
pads and
wrist
supports to
reduce pain.

Carpal
Tunnel
Syndrome Syndroment

Introduction
Carpal
tunnel
syndrome
affects
about 1 in
100 people
at some
point in
their life.
Men and
women of any
age can
develop it,
but it is
most common
in women in
their 30s,
40s and 50s.
Sometimes
carpal
tunnel
syndrome is
triggered by
a persons
occupation,
and can lead
to the
person being
unable to
work. Most
cases of
carpal
tunnel
syndrome can
be prevented
by stopping
or reducing
the activity
that
stresses the
fingers,
hand, or
wrist, or by
changing the
way in which
activities
are done.
Carpal
Tunnel
Syndrome is
a condition
where there
is excessive
pressure on
the median
nerve. This
can be
caused by
swelling in
the carpal
tunnel
and/or
thickening
of the
transverse
carpal
ligament,
which forms
the roof of
the carpal
tunnel
Pinching or
compression
of this
nerve by the
transverse
carpal
ligament
sets into
motion a
progressively
crippling
disorder
which
eventually
results in
wrist pain,
numbness and
tingling in
the hand,
pain
consisting
of a pins
and needles
feeling at
night,
weakness in
grip and a
feeling of
in
coordination.

Symptoms
Patients
with carpal
tunnel
syndrome
initially
feel
numbness and
tingling of
the hand in
the
distribution
of the
median nerve
(the thumb,
index,
middle, and
part of the
fourth
fingers).
These
sensations
are often
more
pronounced
at night and
can awaken
patients
from sleep.
The reason
symptoms are
worse at
night may be
related to
the
flexed-wrist
sleeping
position
and/or fluid
accumulating
around the
wrist and
hand while
lying flat.
Carpal
tunnel
syndrome may
be a
temporary
condition
that
completely
resolves or
it can
persist and
progress.

As the
disease
progresses,
patients can
develop a
burning
sensation,
cramping and
weakness of
the hand.
Decreased
grip
strength can
lead to
frequent
dropping of
objects from
the hand.
Occasionally,
sharp
shooting
pains can be
felt in the
forearm.
Chronic
carpal
tunnel
syndrome can
also lead to
wasting
(atrophy) of
the hand
muscles,
particularly
those near
the base of
the thumb in
the palm of
the hand.

Treatment

Carpal
tunnel
syndrome
treatment
usually
begins
conservatively,
and moves to
more
aggressive
and invasive
techniques
if the
symptoms of
carpal
tunnel
syndrome
persist.
The initial
carpal
tunnel
syndrome
treatment
steps
include some
medications
and splints
Doctor at A+
clinic may
ask you to
rest your
wrist or
change how
you use your
hand. Doctor
may also ask
you to wear
a splint on
your wrist.
The splint
keeps your
wrist from
moving but
lets your
hand do most
of what it
normally
does. A
splint can
help ease
the pain of
carpal
tunnel
syndrome,
especially
at night.
Putting ice
on your
wrist,
massaging
the area and
doing
stretching
exercises
may help
too.
Cotisone
injecions
provide
temporary
relief as is
it injected
directly
into the
affectd area
to decrease
inflammation
around the
nerve.
Surgical
treatments
are
available
and
effective in
the
treatment of
carpal
tunnel
syndrome.
The most
common
procedure is
the carpal
tunnel
release. A
carpal
tunnel
release
involves
making an
incision in
the fibrous
sheath
around the
carpal
tunnel. By
releasing
tension in
the carpal
tunnel, the
pressure is
removed from
the nerve.

Rehabilitation
Exercise
wil help to
strenghthen
the wrist
and prevent
the symptoms
of carpal
tunnel
syndrome.

Tips for
relieving
carpal
tunnel
syndrome
 Prop up
your arm
with pillows
when you lie
down.
 Avoid
using your
hand too
much.
 Find a new
way to use
your hand by
using a
different
tool.
 Try to use
the other
hand more
often.
 Avoid
bending your
wrists down
for long
periods.

Introduction
A colles
fracture is
defined as a
break across
the end of
the large
bone of the
forearm
called the
radius.

Cause
As with most
types of
wrist
fractures a
fall is the
primary
cause of a
colles
fracture.
The impact
of the fall
and
bodyweight
causes the
radius to
buckle. The
young and
elderly are
particularly
susceptible
to this
fracture as
children's
bones are
soft and
elderly
patients
bones tend
to be
brittle. In
the elderly
a condition
called
osteoporosis
can often
lead to a
colles
fracture.
Osteoporosis
is a bone
disorder.
The bones
become
thinner,
lose their
strength,
and are more
likely to
break.
People with
osteoporosis
have a
higher risk
of
fractures.
Their bones
can fracture
even during
everyday
movements,
such as
bending or
coughing.
Osteoporosis
is not a
form of
arthritis,
although it
can cause
fractures
that lead to
arthritis.It
is more
common in
women than
men and
people with
osteoporosis
usually
fractured
the wrist
first. This
typically
occurs
between ages
50 and 70 in
women.

Treatment
 Elevate
the wrist
and place in
a sling.
 Place a
ice pack on
the wrist to
reduce the
swelling.
 Do not
attempt to
move the
wrist
 Visit a
doctor for
x-rays and
casting
Generally
fracture
need
reduction
(putting
back in
position)
and a very
specialized
plaster is
applied. The
plaster is
generally
stay for 6
weeks. The
doctor at A+
clinic will
regularly
get the
X-ray done
to make sure
that the
fracture is
well
aligned. At
6 weeks the
plaster is
removed at
the clinic
and
rehabilitation
is started.

Rehabilitation
Rehabilitation
begins by
maintaining
the range of
movement in
the fingers,
thumb and
shoulder, on
the side of
the affected
wrist. This
will help to
prevent
stiffness in
these areas.
The
rehabilitation
last for 3-4
weeks.

Introduction
The scaphoid
is one of
the small
bones in the
wrist
(carpal
bones), and
the one that
is most
likely to
break. The
scaphoid is
a kidney
shaped bone
and sits
below the
thumb.A
scaphoid
fracture
often occurs
when a
individual
falls on an
outstretched
arm. The
scaphoid
which is
also known
as the
navicular is
damaged.
Scaphoid
fractures
account for
about 60
percent of
all wrist
(carpal)
fractures.
They usually
occur in men
between ages
20 and 40
years, and
are less
common in
children or
in older
adults. The
break
usually
occurs
during a
fall on the
outstretched
wrist. Its
a common
injury in
sports and
motor
vehicle
accidents.
The angle at
which the
wrist hits
the ground
determines
the injury.
If the wrist
is bent at a
90-degree
angle or
greater, the
scaphoid
bone will
break; if
the angle is
less than 90
degrees, the
lower arm
bone
(radius)
will break.
It has its
own blood
supply which
is why a
fracture can
damage this
blood supply
causing
delayed or
no healing
to the
fracture. A
complete
loss of
blood supply
to the bone
can cause
death to the
bone. This
condition is
called
avascular
necrosis (Avascular
means no
blood
supply, and
necrosis
means
dead.).
Often
patients
present with
wrist pain
following a
fall and the
x-ray does
not
immediately
show damage
to the
scaphoid.
Persistent
pain and
follow up
x-rays can
be required
to correctly
diagnose the
condition.

Symptoms
The symptoms
of a fresh
fracture of
the scaphoid
bone usually
include pain
in the wrist
and
tenderness
in the area
just below
the thumb
(snuff box).
You may also
see swelling
around the
wrist. The
swelling
occurs
because
blood from
the
fractured
bone fills
the wrist
joint. Thin
people will
see a
bulging of
the joint
capsule. The
joint
capsule is
the
watertight
sac that
encloses the
joint.
Pain may
subside,
then return
as a deep,
dull aching
and gripping
anything may
be painful.
Treatment
 If
fracture is
incomplete
or
undisplaced
casting is
for 9 to 12
weeks. This
is necessary
to hold the
scaphoid
bone very
still while
it heals.
 If
fracture is
displaced
surgery such
as screw
fixation,
scaphoid
debridement
and bone
grafting may
be needed.

Rehabilitation
The amount
of time the
patient
needs to
wear the
cast depends
on what part
is fractured
and whether
the bones
heal well.
When the
doctor at A+
clinic is
certain the
bones have
healed, the
cast will be
removed. The
wrist will
probably be
stiff and
weak from
being in the
cast.
Following
the casting
it is
recommended
to wear a
wrist
support and
carry out
wrist
strengthening
exercises to
help
strengthen
and
stabilize
the muscles
around the
wrist joint.

Wrist
Tendonitis

Introduction
Wrist
Tendonitis (DeQuervains
Tendonitis)
can be
defined as
an
irritation
and swelling
of the
sheath or
tunnel which
surrounds
the tendons
of the
thumb.
Typically
the pain
will be
present at
the front of
the wrist.
Pain will be
initiated
when
grasping an
object or
pinching the
fingers,
Some
patients
present with
a lump in
the wrist
directly
above the
carpal
tunnel. This
indicates
that the
condition
has advanced
as there may
also be a
balloon of
joint fluid
formed in
that area.
Localized
swelling may
be present
and making a
fist or
bending the
wrist will
initiate
pain.
Cause
 This is
commonly a
over use
injury which
results in
inflammation
of the
lining
around the
tendon.

Biomechanical
condition
with the
wrist.

Inappropriate
technique
with certain
racket sport
such as
tennis,
badminton or
contact
sports such
as boxing.
 A fall.

Treatment
 R.I.C.E:
Rest (Avoid
using your
injured
wrist and
hand), Ice
(Apply ice
or a cold
pack to the
wrist for
15-20
minutes, 4
times a day
for several
days,
Compression
(Wrap your
wrist in an
elastic
support.
This will
limit
swelling and
support your
wrist) .and
Elevation (
Keep the
injured
wrist raised
above the
level of
your heart
for 48 hours
such as up
on a pillow.
This will
help drain
fluid and
reduce
swelling).
 Anti-inflammatories
(seek advice
from doctor
before
commencing
this
treatment)
 Stretching
exercises.

Rehabilitation

The
exercises
above will
help to
strengthen
the wrist.
Please note
that these
should only
be attempted
when the
initial
tendonitis
has subsided
and you wish
to
strengthen
the wrist.
If any pain
is initiated
from these
exercises
then you
should
immediately
cease the
exercises.
Wrist
supports
will also
help to
speed up
recovery and
prevent
further
injury.

Wrist Gout

IntroductionGout is a
condition in
which uric
acid, a
waste
product that
occurs
naturally
occurring
within the
body, rises
above normal
levels.
Rather than
being
flushed by
the kidneys
and through
the urine,
as it
normally is,
it forms
crystals and
deposits in
the joints.
These
deposits
give rise to
inflammation
of the
joints,
causing
pain,
swelling,
redness and
tenderness
of the area.
Most
typically
the joint
affected is
that of the
big toe, but
gout can
also affect
the wrist
Uric acid
crystals may
also form
deposits in
other areas
such as
under the
skin or in
other soft
tissues, and
in the
kidney or
urinary
tract.

Gout of the
Right Wrist:
Note
swelling and
redness over
right wrist
area. Left
wrist is
normal.

Cause
The cause of
gout is an
inflammation
in your
joint
resulting
from an
accumulation
of urate
crystals.
Uric acid is
a waste
product
formed from
the
breakdown of
purines.
These are
substances
found
naturally in
your body as
well as in
certain
foods,
especially
organ meats
 such as
liver,
brains,
kidney and
sweetbreads
 and
spinach,
asparagus
and
mushrooms.
Obesity can
be linked to
high uric
acid levels
in the
blood.
People who
are
overweight
should
consult with
their doctor
to decide on
a reasonable
weight-loss
program.
Fasting or
severe
dieting can
actually
raise uric
acid levels
and cause
gout to
worsen.
Crystal
deposits
also cause
another
condition,
known as
false gout (pseudogout).
But rather
than being
composed of
uric acid,
pseudogout
crystals are
made of
calcium
pyrophosphate
dihydrate.
And while
pseudogout
can affect
the big toe,
it's more
likely to
attack large
joints such
as your
wrists.

Rehabilitation
Prevention
with diet
and a
healthy
lifestyle is
better than
cure.
However,
during a
gout attack
on the wrist
you may find
that an
elasticated
wrist
support will
help also a
reusable hot
and cold
will reduce
the
inflammation.
Freeze the
cold pack
and apply it
to your
wrist.

Wrist
Exercises Exercises

The
following
hand and
finger
exercises
should be
done during
the
rehabilitation
of an wrist
injury,
provided
they do not
initiate any
pain. Please
refer to
your
physician if
in doubt.

Recommended
Products to
Strengthen
the Wrist

Hand
exerciser
that
uniquely
works
through a
full,
natural,
3-dimensional
range of
motion. This
reciprocal
muscle
exercise
strengthens,
conditions
and balances
the tissues
of the hand,
wrist,
fingers and
forearm.
The Ultimate
Hand Helper
was designed
to be
comfortable,
effective
and
versatile.
The ultimate
hand helper
helps to
strengthen
the hand and
wrist
muscles.
Indications:

Rehabilitation
use after
fracture.
 Cumulative
trauma
injuries
(sprains to
tendonitis)
 Carpal
Tunnel
Syndrome
 Arthritis